Dissociation as the Limit
What Happens When Self-View Fixation is Ignored for Too Long
In 2022, a post appeared on the r/AutismInWomen subreddit that garnered hundreds of replies (and even four years later, at the time of writing this book, fresh responses are still appearing). A woman described a sensation that haunted her after several hours of video calls: "Maybe it has to do with seeing yourself on the screen... It's like my brain asks, 'If I am over there on the screen, then who is in this body?'"
The comments under the post were astonishingly unanimous. "I get the exact same thing. After a long call, it feels like I'm not entirely real." "I look at my hands and don't recognize them." "Sometimes after Zoom, I need half an hour just to feel like me again." Some described the sensation even more precisely: "The face on the screen was me. But the face in the bathroom mirror after the call felt like someone else." Several people admitted they started avoiding mirrors after work—not out of dissatisfaction with their appearance, but due to a strange feeling that the reflection wasn't "quite theirs."
Despite the subjective nature of these forum descriptions, they match the clinical definition of depersonalization almost word for word. And, of course, they are not limited to autistic women: similar testimonies can be found in dozens of threads across various forums. But it was neurodivergent individuals—with their heightened sensitivity to sensory conflict—who described this experience earlier and more accurately than others.
When "I" Becomes "He"
Depersonalization is the experience of detachment from oneself. A person feels as though they are observing themselves from the outside, that their body does not belong to them, and that their actions are occurring somewhat automatically, without their participation. In the International Classification of Diseases (ICD-11), this state is described as "an experience of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions." A related but distinct experience is derealization: the feeling that the surrounding world is unreal, as if everything around is a stage set or a dream.
Episodes of depersonalization are experienced at least once in a lifetime by 25% to 75% of people, according to various estimates [1]. Typically, these are brief states provoked by severe stress, fatigue, or sleep deprivation. They are unpleasant, but they pass on their own. Depersonalization becomes a clinically significant disorder when episodes become more frequent, prolonged, and begin to interfere with daily life—the person feels "disconnected" from their own experience not for minutes, but for hours and days.
Crucially, depersonalization is not a psychosis. A person experiencing it does not lose touch with reality in a psychotic sense: they understand where they are, who they are, and what is happening around them. What they lose is the feeling that whatever is happening is happening specifically to them. Awareness is preserved, but the experience of involvement is disrupted.
This is exactly why depersonalization so often goes undiagnosed. The person cannot explain what is wrong with them. Depersonalization doesn't look like hallucinations or delusions, and the patient doesn't typically fall into a panic (although anxiety is its most frequent companion). They simply feel "a bit out of it." And they might write it off as fatigue, boredom, a stuffy room, or bad sleep (or jump to the other extreme: "I'm losing my mind"). In clinical practice, patients with depersonalization often go years without seeking help because they don't know what to call their condition. Many reason like this: "If I tell them everything feels 'fake,' they'll lock me up in a psych ward."
Indeed, in Soviet psychiatry, for example, derealization and depersonalization could be viewed as manifestations of "sluggish schizophrenia," especially if they were prolonged, accompanied by reflection, and lacked full-blown psychosis. In the US, prior to the release of the DSM-III in the 1980s, depersonalization could be interpreted as a "lack of contact with reality" and a key marker of psychosis. The state of derealization and depersonalization was sometimes termed "pseudoneurotic schizophrenia" or "pre-psychosis," which also led to heavy diagnoses. Many classical European psychiatrists viewed depersonalization as part of the prodromal (initial) phase of schizophrenia. A patient could be diagnosed with "latent" or "prodromal" schizophrenia and started on preventative neuroleptic treatment, which in itself could lead to hospitalization [6].
Naturally, in the form of myths, misconceptions, and urban legends, these artifacts of past psychiatry still exist in the public consciousness today. However, in reality, such an approach is considered completely obsolete in modern clinical practice. Contemporary clinical psychology and psychiatry clearly distinguish transient dissociative experiences caused by overload (which is exactly what we are dealing with in self-view fixation) from psychotic disorders. Episodic depersonalization is a fairly common and generally benign condition, especially when it is directly linked to a specific trigger.
As a practicing clinical psychologist, I can add that I encounter complaints about states of derealization and depersonalization from clients quite regularly. These experiences arise particularly often during panic attacks—and frequently become one of the most frightening and distressing symptoms of the entire episode. However, in therapy, they are generally well-managed and tend to weaken quite quickly.
The Splitting of Bodies (On Screen and In Front of It)
Let's examine exactly how fixation on one's own image can create a feeling of depersonalization.
The human sense of "I"—what neuroscience calls the sense of body ownership—is maintained by the continuous integration of signals from various sources: visual, proprioceptive (the sense of the body's position in space), tactile, and vestibular. The brain constantly "stitches" these streams together to form a unified image: this is my body, it is here, and I am in it. When the streams are aligned, the feeling of presence is taken as a given. It is so automatic and habitual that we don't notice it.
The self-view creates a misalignment. On the screen, we have a face that the brain tags as "mine" (as we remember from Chapter 2, one's own face is a highest-priority self-relevant stimulus). But this face is two-dimensional, mirror-flipped, delayed by a fraction of a second, and distorted by a wide-angle lens. It is located "over there"—at arm's length, among other faces, inside a rectangle. Meanwhile, the body to which this face belongs is located "right here"—in a chair, possessing weight, warmth, breath, the feeling of fabric under the fingers, and all the other tactile aspects of offline life.
Neuroscience has long known that a conflict between visual and proprioceptive channels can temporarily "shift" the sense of body ownership. A classic example is the rubber hand illusion, in which synchronous stroking of a visible rubber hand and the hidden real hand causes a person to feel the rubber hand as their own. You can easily find one of the many videos about this illusion online and run the experiment at home with friends or children (a stuffed glove works perfectly well instead of a rubber hand). The effect occurs in minutes: when a visual signal systematically conflicts with a proprioceptive one, the brain resolves the conflict in favor of vision.
In the case of the self-view, we can say that the image of your body on the screen becomes the analog of the rubber hand. The principle is the same: a synchronous visual image of yourself, presented over an extended period, begins to compete with the bodily sensation of yourself.
In short bursts, the brain handles this split just fine: "I am here, and that over there is my image." But with multi-hour, daily exposure, when attention repeatedly flows to the flat face on the screen, the balance can shift in favor of the looking-glass. The visual channel directed at the self-view begins to compete with the body's proprioceptive and interoceptive signals. And if the visual channel wins—and for the brain, as we've discovered, vision, especially of one's own face, is always the priority—the person begins to feel that the "real me" is over there on the screen, rather than right here in the chair!
This is the mechanism of the dissociative split provoked by the self-view: a conflict between the visual image of the self (flat, external, observed) and the bodily experience of the self (volumetric, internal, felt). The longer the conflict lasts, the weaker the bodily pole becomes, because attention is systematically withdrawn from the body and directed toward the screen image.
The Loss of the Sense of Self
In Chapter 2, we described how the self-view creates a background cognitive load: the brain continuously processes its own image even when the person isn't consciously looking at it. But this isn't the only expense in the brain's budget. Prolonged fixation on an external image of oneself also suppresses interoception—the ability to read signals from one's own body: heartbeat, breathing, muscle tension, hunger, and fatigue.
Interoception allows us to recognize fatigue before it becomes exhaustion, and anxiety before it spirals into panic. The popular advice to "listen to your body" in a clinical sense means exactly this: restoring this internal focus.
Reduced interoception is a known neurophysiological predictor of anxiety and eating disorders [2]. A person who struggles to read their body's signals generally struggles to regulate their emotions—precisely because they fail to catch them in the early stages when regulation is still manageable. They only "wake up" when they are already in the middle of a panic attack, a state of exhaustion, or a binge.
Self-view fixation systematically redirects attention from the internal to the external: that is, from the feeling of the body to the image of the body. It is an exteroceptive fixation that suppresses interoception. And this is exactly why so many people describe their state after a long video call not as ordinary physical fatigue, but as a strange emptiness, a loss of contact with themselves. The body (and the brain itself as part of the body) is tired, but the person didn't "feel" it until the very end, because the entire time they were on the call, their attention was directed outward, at the screen. The signals were there, but they weren't reading or reacting to them. It's like sitting in an uncomfortable position and not noticing it, only to find you can barely stand up later because you ignored your body's signals and your leg went numb.
Data: The Digital Environment and Depersonalization
The link between screen time and dissociative experiences remained at the level of clinical observation for a long time: psychotherapists noticed it, but quantitative data was lacking. In 2022, a group of researchers published a study in Nature Scientific Reports that measured this connection. The study included 622 participants. It measured the intensity of digital media use and the severity of depersonalization and derealization symptoms using standardized scales. The result: a statistically significant positive correlation. This association remained significant even after controlling for demographic variables and baseline trait anxiety—meaning it couldn't be explained away by age, gender, or pre-existing anxiety [3].
The study was not specifically focused on the self-view—it examined the digital environment as a whole. But the self-view, as we've shown in previous chapters, concentrates several key "toxicities" of this environment simultaneously: forced self-observation, conflict between the visual and bodily self-image, and the chronic shifting of attention from internal to external signals. If digital media in general are associated with an increase in depersonalization, then the self-view is their most concentrated form in the context of professional communication and other online interactions.
We should add another observation made in a completely different field. Matthew Santoso and Jeremy Bailenson (who is already familiar to us from Stanford), studying video passthrough technology in virtual reality headsets in 2024, discovered an effect they called "social absence": real people nearby were perceived by headset users as less present, as if they were on a video call [5]. Moving the visual experience into the screen—whether a flat monitor or a VR headset—weakens the experience of the reality of the surrounding world! The self-view adds to this by weakening the experience of the bodily reality of the self.
Not a Type, But an Outcome
In Part II, we described seven archetypes—stable motives for looking at the self-view. Dissociation is not an eighth "motive"; no one, we presume, looks at their self-view out of a desire to dissociate. Dissociation is a potential outcome for any of the seven archetypes if the vicious cycle operates long enough without intervention.
The Controller, who spends six months checking their facial expression every thirty seconds, might find by the end of the workday that they feel "switched off from themselves." The Objectified, who spends hours fixating on perceived appearance flaws, might start to feel that the face on the screen isn't theirs, but someone else's—unpleasant and frightening. The Hider, who uses the self-view as a refuge from the pressure of other faces, risks retreating so far into this window that they lose contact not only with their colleagues but with their own body. The Face-Saver, for whom the self-view is a tool for maintaining group harmony, might find after a multi-hour meeting that the "mask has fused to their face": the feeling of their own face in the bathroom mirror no longer matches reality. The Overwhelmed, whose attention is hijacked by a moving stimulus for hours, drains their cognitive resources to the point where the brain, simply put, just "shuts down" the experience of presence to save whatever little energy is left. The Fascinated, much to their surprise, is also not immune to dissociation.
The path for each archetype will be different. But the destination in a negative scenario is the same—the feeling that "I" and what is on the screen are no longer the same thing. Or, more precisely, that "I" am no longer quite the same person I was a minute ago.
In turn, these dissociative experiences themselves frequently become the breeding ground for secondary anxiety. A person becomes afraid of the very feeling of "unreality" or "disconnection from self." This additional anxiety can trigger or significantly worsen panic attacks and other anxiety disorders. This is why it is so crucial not to push the situation to the breaking point and to reduce the load from the digital mirror in time.
This is exactly why this chapter (and by no means as a "scare tactic") is placed here, at the beginning of the practical section. Our goal is to provide a reasoned argument that fixation on the self-view is, at its limit, a condition that affects the foundational experience of the "self." And if you recognized yourself in any of the archetypes in Part II, it means it makes sense to act. Not because dissociation is inevitable (as a practitioner, I can say that thankfully, it absolutely is not!), but because stepping off the path that leads the brain in that direction is far easier than recovering from it. Modern humans already have so much chronic stress in their lives; why not eliminate at least one source of it?
When a Specialist is Needed
Most people who recognize themselves in the descriptions above do not need psychotherapy. Episodic feelings of "disconnection" after long video calls are the nervous system's normal reaction to an abnormal load. They pass on their own when the load is reduced (which is what the next chapter is all about).
However, there are markers that indicate it is time to consult a specialist—a psychologist or psychotherapist who works with anxiety and/or dissociative states.
- First is duration. If the feeling of detachment does not pass within a few hours or more after the video calls end, and persists in situations unrelated to screens, it is a cause for concern.
- Second is frequency. If the episodes recur regularly (several times a week) and you notice they are becoming more frequent rather than less.
- Third is functional decline. If the feeling of "unreality" begins to interfere with work, socializing, or rest. If you catch yourself unable to focus on a conversation not because you're simply distracted, but because you don't feel fully "present."
- Fourth is concurrent anxiety or panic. As we mentioned earlier, depersonalization is often accompanied by secondary anxiety: the person becomes frightened by the feeling of alienation itself, which triggers another vicious cycle—anxiety about detachment intensifies the detachment.
If at least two of these four markers are present, it makes sense to speak with a professional. Depersonalization responds well to therapy, particularly Cognitive Behavioral Therapy [4]. The specialist doesn't need to be familiar with "self-view fixation" specifically; experience with dissociative states or anxiety disorders is enough. What you absolutely should not do is ignore what is happening and try to "escape" it by scrolling through content on your phone. Yes, everyone gets tired, and these things happen. But if "happens" ceases to be an episode and becomes a regular state, it should no longer be considered the norm.
The most important thing to remember is that all the states described above are reversible. And you can start this process right now—by turning off the self-view in the settings of your video conferencing platforms, along with a few other solutions outlined in the next chapter.
References
[1] Hunter, E. C. M., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalisation and derealisation: A systematic review. Social Psychiatry and Psychiatric Epidemiology, 39(1), 9–18.
[2] Paulus, M. P., & Stein, M. B. (2010). Interoception in anxiety and depression. Brain Structure and Function, 214(5–6), 451–463.
[3] A study published in Nature Scientific Reports (2022, N \= 622) recorded a statistically significant association between the intensity of digital media use and symptoms of depersonalization/derealization. [Verify full publication details before publishing.]
[4] Hunter, E. C. M., Baker, D., Phillips, M. L., Sierra, M., & David, A. S. (2005). Cognitive-behaviour therapy for depersonalisation disorder: An open study. Behaviour Research and Therapy, 43(9), 1121–1130.
[5] Santoso, M., & Bailenson, J. N. (2024). Diminished social presence in video passthrough. [Verify full publication details before publishing.]
[6] Rzesnitzek, L. (2013). "Early Psychosis" as a mirror of biological controversies in post-war German, Anglo-Saxon, and Soviet Psychiatry. Frontiers in Psychology, 4, 481.